Provider Lifecycle Management

It is critical for payers, in the healthcare industry, to invest in effective, end-to-end provider life-cycle management platforms to enhance network management, reduce costs and ensure ease of access to high quality care. However, payers today have limited provider management capabilities. This, stitched together with legacy applications, manual processes, and error-prone point-solutions, creates long provider onboarding times and causes major data quality issues. Some of the other key challenges include:

With Virtusa PLM, you can address the multiple challenges you face in each of the following phases of managing your relationship with providers and also manage your provider network effectively.

Features of the PLM offering

Robotic Automation The PLM platform has market leading robotic capabilities, where significant processes, specifically around credentialing, are automated and the processes are completed without any human intervention. Removing the manual steps from Primary Source Verification can save more than 80% of ‘resources time’ for payers. The solution supports the ability to use robotics from data Intake, to credentialing, to loading demographic and pricing data into systems.

Pre-built Integrations

The PLM platform has pre-built integrations for both internal and external sources of data. Organizations looking for external sources of provider data will be able to utilize our integration for import thousands of data elements from CAQH. Similarly, the platform supports seamless integrations with internal contracting systems, credentialing systems, claims systems, provider directories and more by modeling the data for upstream and downstream usage. With these in-built integration ,the quality of providers and data is greatly enhanced.

Interactive Dashboards & Reporting The PLM platform provides users a clear view into their most critical cases, work items, performance reports, and other insights through interactive dashboards with a rich user experience. Customer services can now give providers accurate updates on their overall on-boarding progress and status.

Automated Roster File Management The PLM platform enables payers to bulk process roster data from multiple sources consistently. The solution standardizes data (and complex processes) involved in accurately in-taking, formatting, transforming, and loading of data from multiple provider organizations into downstream systems. The Roster File Management capabilities take this manual and repetitive process and automate it to significantly increasing operational efficiency and quality as well as accuracy of data.

Intelligent Workflow Management The PLM platform is built on leading enterprise platforms that empower organizations to manage multi-departmental workflows and complex provider data structures. The solution has built in smart business rules, document checklists, intelligent case routing, pre-defined state-based rules, business admin portal, and many other capabilities that significantly improve operational efficiencies for provider & network Management organizations.

Digital Enablement The PLM platform will drive the digital transformation of the provider and network management organizations at payers. The platform modernizes the intake of information (online professional and ancillary credentialing applications) and enables eSignature capabilities through the contracting process. PLM provides an omni-channel approach to access information, delivers a user-centered design with superior UX/UI, and increases user adoption – both internally and externally with providers.

Value delivered through the PLM offering

Effectively grow provider network by building trust and reputation while drastically reducing operating costs and risks.